Udo Schneider

I feel good! Gender differences and reporting heterogeneity in self-assessed health

For empirical analysis and policy-oriented recommendations, the precise measurement of individual health or well-being is essential. The difficulty is that the answer may depend on individual reporting behaviour. Moreover, if an individual’s health perception varies with certain attitudes of the respondent, reporting heterogeneity may lead to index or cut-point shifts of the health distribution, causing estimation problems. An index shift is a parallel shift in the thresholds of the underlying distribution of health categories. In contrast, a cut-point shift means that the relative position of the thresholds changes, implying different response behaviour. Our paper aims to detect how socioeconomic determinants and health experiences influence the individual valuation of health. We analyse the reporting behaviour of individuals on their self-assessed health status, a five-point categorical variable. Using German panel data, we control for observed heterogeneity in the categorical health variable as well as unobserved individual heterogeneity in the panel estimation. In the empirical analysis, we find strong evidence for cut-point shifts. Our estimation results show different impacts of socioeconomic and health-related variables on the five categories of self-assessed health. Moreover, the answering behaviour varies between female and male respondents, pointing to gender-specific perception and assessment of health. Hence, in case of reporting heterogeneity, using self-assessed measures in empirical studies may be misleading and the information needs to be handled with care.

Anreizeffekte und Angebotsinduzierung im Rahmen der Riester‐Rente: Eine empirische Analyse geschlechts‐ und sozialisationsbedingter Unterschiede

Abstract In 2001, the voluntary Riester pension scheme was implemented in Germany. Financial subsidies should provide incentives to increase private pension savings. In this paper, we hypothesize that these publicly subsidized savings are mainly driven by the incentives of child benefits and that supplier induced demand is an important factor. Using data from the Socio-economic Panel we analyze the key determinants in the choice of a Riester-pension. We find a higher probability to sign a Riester contract for those with higher income, higher education and children. Furthermore, we show that a contact with an insurance agent in the previous year is a major factor for the possession of a Riesterpension. Separate estimations regarding gender and socialization confirm our hypothesis of heterogeneous determinants.

Estimating ordered categorical variables using panel data: a generalized ordered probit model with an autofit procedure

Estimation procedures for ordered categories usually assume that the estimated coefficients of independent variables do not vary between the categories (parallel-lines assumption). This view neglects possible heterogeneous effects of some explaining factors. This paper describes the use of an autofit option for identifying variables that meet the parallel-lines assumption when estimating a random effects generalized ordered probit model. We combine the test procedure developed by Richard Williams (gologit2) with the random effects estimation command regoprob by Stefan Boes.

The physician-patient relationship revisited: the patient’s view

The importance of the physician-patient relationship for the health care market is beyond controversy. Recent work emphasizes a two-sided asymmetric information relationship between physician and patient. In contrast to most work looking only at the physician’s perspective, our paper concentrates on the patient’s view. Estimation results support the hypotheses that physician consultation and health relevant behavior are not stochastically independent. In the recursive bivariate probit model, patient’s health relevant behavior has a significant influence on the probability of a physician visit. This means that health care demand and not only the contact decision is determined by both, patient and physician.

Reporting heterogeneity in self-assessed health among elderly Europeans.

IntroductionSelf-assessed health (SAH) is a frequently used measure of individuals’ health status. It is also prone to reporting heterogeneity. To control for reporting heterogeneity objective measures of true health need to be included in an analysis. The topic becomes even more complex for cross-country comparisons, as many key variables tend to vary strongly across countries, influenced by cultural and institutional differences. This study aims at exploring the key drivers for reporting heterogeneity in SAH in an international context. To this end, country specific effects are accounted for and the objective health measure is concretized, distinguishing effects of mental and physical health conditions.MethodsWe use panel data from the SHARE-project which provides a rich dataset on the elderly European population. To obtain distinct indicators for physical and mental health conditions two indices are constructed. Finally, to identify potential reporting heterogeneity in SAH a generalized ordered probit model is estimated.ResultsWe find evidence that in addition to health behaviour, health care utilization, mental and physical health condition as well as country characteristics affect reporting behaviour. We conclude that observed and unobserved heterogeneity play an important role when analysing SAH and have to be taken into account.

Asymmetric Information and the Demand for Health Care - the Case of Double Moral Hazard

The production of health does not only depend on the medical services supplied by the physi-cian but is also influenced by the patient’s compliance. A model of medical treatment is pre-sented in which both the actions of physician and patient are modeled as a productive input. The analysis distinguishes between three cases of strategic interaction. The consequences of asymmetric information between physician and patient are lower activity levels, only in the case of strategic substitutes the result might change. Furthermore, the effects of the implementation of a demand-side coinsurance are discussed.

Health and the Decision to Invest in Education

Summary The paper analyses the relationship between health and education in a two period human capital framework. The resulting substitution and investment effects between health and advanced training work in opposite direction and leave open questions for the empirical part. As econometric model we use a random effects probit model for panel data. Our data consist of 322 individuals for the two years 2004 and 2006. Thereby, we take into account that self-reported measures of health are usually vulnerable to a reporting bias due to anticipation and measurement errors. Estimation results show a dominant substitution effect between different levels of education, indicating that good health implies higher learning efficiency so that the same income can be achieved with lower investment in advanced training. In contrast, we find a dominant investment effect within an educational level, indicating that better health leads individuals with higher education to invest more in additional training.

Health Behaviour and Health Assessment: Evidence from German Microdata

The importance of the individual’s health behaviour for the health production process is beyond controversy. Health relevant behaviour can be viewed as a key variable in the health production process. Changes in the behaviour may influence individual’s assessment of health. Following this idea, we use German microdata to identify determinants of smoking, drinking, and obesity and their impact on health. Our empirical approach allows for the simultaneity of behaviours and self-reported health. In addition, we account for endogeneity of health behaviours and take aspects of reporting heterogeneity of self-reported health into account. We find that health behaviour is directly related to the socioeconomic status and observe gender-specific differences in the determinants of drinking, smoking, and heavy body weight in particular. The influence on health is also gender specific. While we do not find any impact of smoking, overweight is relevant only for males and no clear pattern for alcohol exists.

Improving Prevention Compliance Through Appropriate Incentives:Theoretical Modelling and Empirical Evidence

SummaryThis paper explores the effects of insurance parameters and complementary information environment on the patient’s primary prevention activity. The theoretical model is based on a principal-agent setting in which the patient acts as an agent in deciding about his prevention efforts. The insurer chooses the coverage level and therefore the level of patient’s cost sharing and decides on his monitoring activities. The empirical analysis looks at the patient’s prevention decision in the case of smoking. Using a hazard model in discrete time, the decision to change behaviour depends on health status, education, age and working time but not on the insurance system.

Reporting Heterogeneity in Self-Assessed Health Among Elderly Europeans: The Impact of Mental and Physical Health Status

Self-assessed health (SAH) is a frequently used measure of individuals’ health status. It is also prone to reporting heterogeneity. To control for reporting heterogeneity valid measures of the objective health status are needed. The topic becomes even more complex for cross-country comparisons, as many key variables tend to vary strongly across countries, influenced by cultural and institutional differences. This study aims at exploring the key drivers for reporting heterogeneity in SAH in an international context. To this end, country specific effects are accounted for and the objective health measure is concretized, separating out effects of mental and physical health conditions. We use panel data from the Survey of Health, Ageing and Retirement in Europe (SHARE) which provides a rich dataset on the elderly European population. To obtain distinct indicators for physical and mental health conditions two indices were constructed. Finally, to identify potential reporting heterogeneity in SAH a generalized ordered probit model is estimated. We find evidence that health behaviour as well as health care utilization, mental and physical health condition as well as country characteristics affect reporting behaviour. We conclude that observed and unobserved heterogeneity play an important role when analysing SAH and have to be taken into account.